Anticoagulation Strategies for the Orthopaedic Surgeon: Reversal and Timelines



1 Yale University Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven CT, USA

2 University of Miami Leonard M. Miller School of Medicine, Miami FL, USA

3 Department of Orthopaedic Surgery, St. Elizabeth Medical Center, Brighton MA, USA- Harvard Medical School, Boston, MA, USA


Article Highlights:
1) This article provides a full anticoagulant reference for the practicing orthopaedic surgeon which can be used in any clinical scenario, whether urgent or elective surgical intervention is required
2) A comprehensive list of anticoagulant reversal agents and drugs with short half-lives (for bridging) are described with the intention to provide the data needed to safely manage a patient peri-operatively during urgent orthopaedic surgical care (i.e. fracture or infection)
3) Half-life and method of excretion for all drugs are included with the intention to accurately guide decisions regarding the appropriate timing of scheduling elective orthopaedic surgical care with regards to anticoagulant metabolism and effect
4) The practicing orthopaedic surgeon using this guide should always consider medical co-management of these complex patients as their medical co-morbidities may not be amenable to anticoagulant reversal or peri-operative cessation of therapy, even for a short period
5) The data contained in this article stands to serve as a foundation upon which institution-specific guidelines regarding the peri-operative management of orthopedic patients on long-term anticoagulation can be developed


1. Baek GH. Are we prepared for geriatric orthopedics?
Clinics in orthopedic surgery. 2010; 2(3):129.
2. Mann NC, Cahn RM, Mullins RJ, Brand DM, Jurkovich
GJ. Survival among injured geriatric patients during
construction of a statewide trauma system. Journal of
Trauma and Acute Care Surgery. 2001; 50(6):1111-6.
3. Barnes GD, Lucas E, Alexander GC, Goldberger ZD.
National trends in ambulatory oral anticoagulant
use. The American journal of medicine. 2015;
4. Raji MA, Lowery M, Lin YL, Kuo YF, Baillargeon
J, Goodwin JS. National utilization patterns of
warfarin use in older patients with atrial fibrillation:
a population-based study of Medicare Part D
beneficiaries. Annals of Pharmacotherapy. 2013;
5. Schoof N, Schnee J, Schneider G, Gawlik M, Zint K,
Clemens A, Bartels DB. Characteristics of patients
with non-valvular atrial fibrillation using dabigatran
or warfarin in the US. Current medical research and
opinion. 2014; 30(5):795-804.
6. Pean CA, Goch A, Christiano A, Konda S, Egol K. Current
practices regarding perioperative management of
patients with fracture on antiplatelet therapy: a
survey of orthopedic surgeons. Geriatric orthopaedic
surgery & rehabilitation. 2015; 6(4):289-94.